Lives Are at Stake; Changes Must Be Made

I’m going to Europe this fall and I’m always struck by the fact that throughout Europe and especially in France, they always have strikes and demonstrations. Since I joined NJAMHAA 21 ½ years ago, I’ve seen that while we agree it is effective to show what the mental health and substance community provides and how much it is depended on, there has never been a strike because providers are mission driven and would never hold back services even for a day from the children and adults who rely on them.

Community-based mental health providers are moving to a fee-for-service (FFS) reimbursement system with some rates that won’t work and the simultaneous removal of State contract dollars, as we have been demonstrating – without going on strike. Data from providers throughout New Jersey indicate that tens of thousands of individuals will lose services if FFS rates are not increased and if contract dollars are not continued while providers make the transition, which should be extended.

So, it is realistic – and frightening – to ask, “What if providers had to close their doors not for a day, but forever, because they were no longer viable?” This has been the experience in other states throughout the country, including Massachusetts, Michigan and Kansas. The move to Medicaid managed care and the concurrent termination of contracts with State dollars resulted in programs and even entire agencies closing, which led to individuals’ mental illnesses and substance use disorders becoming worse and requiring much more expensive treatment in emergency rooms and inpatient hospital units. If positive changes are not made for New Jersey’s FFS system, these same tragedies – which have been occurring due to the long history of insufficient funding – will inevitably occur to a greater degree. Such tragedies can and must be prevented.

Our member providers are so committed to those they serve that they are doing all they can as they face the multiple challenges inherent in the time frame in which FFS is being implemented. However, there is still a limit to what they can do with limited funds. It’s my hope that State legislators and policymakers will invest more State dollars in the community mental health and substance use system to ensure that all children and adults – whether they have Medicaid or they are underinsured or uninsured – so that even though providers refuse to quit, the FFS system won’t have such a devastating impact that it would seem as if providers had gone on indefinite strike.

As a good friend of  mine, Randy Hall, eloquently stated, “People seldom change when they see the light; they only change when they feel the heat.” Our State leaders need to feel the heat, to know what’s at stake: people’s lives.

While the unquantifiable cost of people’s lives is certainly a compelling reason on its own, the quantifiable fiscal cost is also of great concern and cannot be ignored. The cost of community services must be viewed as an investment that yields a tremendous return. Community services cost hundreds of thousands of dollars less than hospital services and save the State millions of dollars every year in prevented emergency room visits, hospitalizations, homelessness and incarceration.

People’s lives and the State’s fiscal situation represent a lot of “heat” that should incite positive change to strengthen and maintain the safety net that is our community mental health and substance use system.